Osteochondrosis in the lumbar region occurs due to deformation and destruction of the cartilaginous tissue of the intervertebral discs.Without cartilage, the vertebrae lose their elasticity and shift, causing pain.According to the WHO, the disease mainly affects people over 30 years old.Women get sick three times more often, which is also associated with age-related changes and a decrease in calcium levels in the body.
Osteochondrosis of the lower back
Of all diseases of the peripheral nervous system, osteochondrosis of the spine accounts for 80%, of which 60-80% affect the lumbar region, consisting of 5 vertebrae.In 40% of people, the first signs of the disease appear between the ages of 30 and 35.In older people, osteochondrosis of the spine is diagnosed in 90% of people.Painful sensations are experienced by 7 out of 10 people, the exacerbation can last from 6 to 16 months.
Development stages
- 1st – the appearance of degenerative disorders, affecting nerve endings and disrupting blood supply.The inflammatory process causes pain that radiates to the legs.The patient feels occasional tingling in the back and buttocks.Appears after intense physical effort.
- 2nd – the outer shell of the intervertebral disc (annulus fibrosus) is destroyed.The distance between the vertebrae is reduced, the nerve endings are compressed, which causes severe, sharp pain.The symptoms are particularly pronounced when walking.
- 3rd – due to excessive mobility of the vertebrae, muscle fibers and nerve endings are compressed.Spasms, numbness, burning pain, hernias occur - displacement of the intervertebral disc in the spinal cord.
- 4th – growth of pathological exostoses on the bone structure.The spine literally “turns to stone”.Progressive osteoarthritis and lack of treatment immobilize the patient.
Reasons for development
The disease develops slowly, under the confluence of a number of circumstances, that is, the development of the disease depends on the influence of not one, but several factors:
- Sedentary lifestyle (physical inactivity), sedentary work, low level of physical activity.At first glance, they are not dangerous.However, with prolonged exposure, muscle tone, called “muscle corset,” is weakened.It supports the spine and internal organs.Thus, physical inactivity causes a disruption in the functioning of a number of systems - blood circulation, breathing, digestion.
- Overweight.With a BMI (Quetelet body mass index) greater than 25 kg/m2, excess weight creates additional stress on the body: it puts pressure on the spine, overloads the joints and impairs blood supply.
- Endocrine pathological processes.Hormonal imbalance, disorders in the functioning of the adrenal glands and the thyroid gland “slow down” the body’s metabolism.Frequent hormonal changes “wash away” calcium from bone tissue, making it weak and brittle.
- Unbalanced diet.Popular and affordable fast food fully satisfies the body's energy needs, while from the point of view of saturating the body with the necessary vitamins and microelements, it is absolutely useless.
- Pathologies and genetic predisposition to diseases of the musculoskeletal system.
- Age-related degenerative changes.Under the influence of time, natural wear and tear of the support system occurs.
In men whose profession involves significant physical activity, lumbar osteochondrosis occurs several times more often.
Symptoms of lumbar osteochondrosis
Pain is the main marker of the onset of the disease and its location.Depending on the nature of the appearance, frequency and duration, a preliminary diagnosis can be made.Most often, patients with lumbar osteochondrosis experience aching pain radiating to the leg, groin and coccyx.In a horizontal position, the discomfort disappears.
Spinal nerves extend from the trunk of the spine to different parts of the body.Each nerve is responsible for a specific area.This is called “segmental innervation”.It is for this reason that the affected nerve “responds” in a specific area: this is how “radicular syndrome” manifests itself.
The spinal nerve map allows you to identify pain with a specific area of the spine: C1-C8 - 8 cervical, T1-T12 - 12 thoracic, L1-L5 - 5 lumbar, S1-S5 - 5 sacral, C0 - 2 coccygeal.Signs of osteochondrosis depending on segmental innervation:
- L3-L4 – weak knee reflex, partial numbness, and episodic loss of sensation are noted along the anterior aspect of the thigh;
- L4-L5 – muscle weakness, the patient is unable to fix his body while standing on the heels, pain and sensitivity disturbances extend to the area from the lower back to the buttock, as well as the entire lateral surface of the thigh (from top to bottom).
- L5–S1 – calf muscle tremors, inability to stand on tiptoe, pain in back of thigh.
In rare cases, the radicular arteries are also involved in the destructive process, causing a stroke - a dangerous pathology in which the patient suffers from paresis and paralysis, as well as dysfunction of the pelvic organs.
Pain reflex symptoms
- Lumbago or lumbago (in this case not sciatica!) – acute pain.Any awkward movement, even sneezing and coughing, causes a spasm.The patient spontaneously changes the position of his body by moving it to the side.An attempt to take a vertical position causes new lumbago.
- Lumbodynia is a dull, aching pain that occurs on one side.Periods of remission are followed by exacerbation, which gradually turns into severe pain.
- Lumboischialgia - painful sensations appear in the leg.
Secondary signs of the disease are not so typical and can easily be confused with symptoms of another problem: impaired sweating (hypohidrosis), pallor of the skin in the affected area due to poor blood circulation, severe dryness and peeling.
Diagnosis
At the initial stage, a complete medical history of the patient is collected.The overall picture should be supplemented by the opinions of a surgeon, an orthopedist, a neurologist and a rheumatologist.Specialists give the patient a visual examination to assess changes in posture, muscle tone and skin sensitivity.
X-ray is performed for the primary diagnosis of lumbar osteochondrosis of the 1st degree;it allows you to examine the condition of the intervertebral discs, pathologies of the spinal cord, and also to assess the general condition of the spine.However, this type of diagnosis does not provide complete information about the affected tissues.
Computed tomography (CT) is a very sensitive examination using a beam of ionizing rays.The scanner records the degree of disc deformation, inflammatory processes in the spinal cord membrane and nerve endings in a layer-by-layer image.
Magnetic resonance imaging (MRI) informatively shows the general condition of muscle mass, blood vessels and ligaments.Detects tumors and inflammatory processes.
Myelography is one of the ways to visually assess the condition of the spinal cord and nerve roots by injecting a contrast agent using a needle into the cavity between the pia mater and the arachnoid of the spinal cord, filled with cerebrospinal fluid.Similar to CT, MTP and X-ray, the procedure is performed in real time.
Neurological examination of sensitivity and reflexes for pathologies is a set of studies that includes a screening method for studying limb symmetry, testing vibration sensitivity and assessing Babinsky, Chaddock and Oppenheiman reflexes.
Treatment of lumbar osteochondrosis
The effectiveness of conservative treatment is achieved through a combination of drugs of different groups, massage and manual therapy.However, at stage 3, lumbar osteochondrosis can no longer be cured by conservative methods;surgery is necessary.One of the surgical methods for osteochondrosis is microdiscectomy.This is a neurosurgical operation aimed at removing a hernia without damaging the nerve structures.It is carried out under general anesthesia.The patient can walk from the 3rd day.
Drug therapy (for stages 1-2)
- Analgesics to relieve pain: local (ointments, gels), oral (tablets, suspensions), intramuscular (solutions for injection).
- Nonsteroidal anti-inflammatory drugs to prevent the development of the inflammatory process.Reduces temperature, eliminates swelling.Most often, gels and tablets are used, in more severe cases (inflammation of the sciatic nerve) - injections.Prima Course - 7-14 days.
- Muscle relaxers.Prescribed in the acute period for muscle spasms, as well as during the period of remission to consolidate the effect.
- Chondroprotectors.Blocks destructive processes in intervertebral discs, promotes regeneration, improves metabolism of cartilaginous tissues.
- Vascular drugs.Helps to normalize blood supply to the musculoskeletal system.
- Vitamin complexes of group B. Improve nerve conduction.
- Diuretics.Reduces swelling.
As emergency help in case of exacerbation, powerful injections are used - paravertebral blockade, which causes temporary loss of sensitivity.
It is also recommended to undergo a course of manual therapy twice a year, which relieves muscle tension and spasms, restores blood circulation, improves lymphatic circulation and increases mobility of the musculoskeletal system.
Prevention
- Active lifestyle combined with moderate physical activity;
- Choose comfortable or, if indicated, orthopedic shoes;
- Good diet;
- Body weight control;
- Sleep only on an orthopedic mattress and pillow;
- Office furniture only with flat back;
- Refusal of heavy loads on the back and spine.When carrying heavy objects, the load should be distributed evenly between both hands.